连续性血液滤过联合血液灌流治疗重症药疹患者临床研究

Clinical Study of Continuous Hemofiltration Combined with Hemoperfusion in Treatment of Severe Drug Eruption

目的:研究应用连续性血液滤过(Continuous hemofiltration,CHF)联合血液灌流(Hemoperfusion,HP)治疗重症药疹(Serious drug eruptions,SDE)患者的临床疗效。方法:72例SDE患者随机分为两组:常规组采用常规治疗,CHF+HP组在常规治疗基础上早期行CHF联合HP治疗。在治疗前及治疗1、2周后,两组分别检测血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)及血小板(PLT)水平变化,并行对比分析;在治疗1周后观察比较全身皮疹状况改善程度,并比较患者单位激素累积剂量、并发多器官功能障碍综合征(MODS)及死亡例数。结果:常规组总效有效率为58.33%,CHF+HP组为88.89%,比较差异有统计学意义(P<0.05);治疗1周后,两组炎性细胞因子比较,差异均有统计学意义(P<0.05);治疗2周后,两组IL-6、IL-10及CRP比较,差异均统计学意义(P<0.05);治疗期间两组激素累积剂量比较,差异有统计学意义(P<0.05);常规组并发MODS为20例(55.6%),CHF+HP组为9例(25.0%),比较差异有统计学意义(P<0.05);CHF+HP组死亡4例(11.1%),常规组为14例(38.9%),比较差异有统计学意义(P<0.05)。结论:CHF联合HP治疗SDE,临床治疗效果好,患者病死率降低,值得临床推广应用。

Objective:To study the clinical efficacy of continuous hemofiltration(CHF)combined with hemoperfusion(HP)in treatment of serious drug eruptions(SDE).Method:72 cases of SDE were randomly divided into two groups:the conventional group received conventional treatment,and CHF+HP group received CHF combined with HP treatment on basis of conventional treatment.After treatment,1 week and 2 weeks after treatment,the changes of serum TNF-α,IL-6,IL-10,CRP and PLT levels were detected in two groups.After 1 week of treatment,the improvement of body rash was observed and compared.The cumulative dose of hormone,concurrent the multiple organ dysfunction syndrome(MODS)and the number of deaths were compared.Result:The total effective rate of conventional group was 58.33%,CHF+HP group was 88.89%,the difference was statistically significant(P<0.05).After 1 week of treatment,the inflammatory cytokines in two groups were compared,the differences were statistically significant(P<0.05);after 2 weeks of treatment,the IL-6,IL-10 and CRP of two groups were compared,the differences were statistically significant(P<0.05);the hormones cumulative dose of of two groups were compared,the difference was statistically significant(P<0.05);the complicated with MODS in conventional group of 20 cases(55.6%),CHF+HP group of 9 cases(25.0%),the difference was statistically significant(P<0.05),the deaths of CHF+HP group of 4 cases(11.1%),and conventional group of 14 cases(38.9%),the difference was statistically significant(P<0.05).Conclusion:CHF combined with HP in treatment of SDE,the clinical treatment effect is good,the mortality rate of patients is reduced,so it is worthy of clinical application.